血液透析联合血液灌流对尿毒症患者毒素清除率及颈动脉内膜的影响

摘要

目的:探讨血液透析(HD)联合血液灌流(HP)对尿毒症患者体内毒素清除率及颈动脉内膜的影响.方法:选取我院收治的尿毒症患者40例,随机分为对照组(n=20)和研究组(n=20),2组均进行常规HD治疗,研究组同时联合HP治疗,连续治疗3个月.检测并比较治疗前后2组毒素含量及清除率、血清炎性因子水平;采用超声诊断仪检测治疗前后2组劲动脉内膜中层厚度(IMT)变化.结果:治疗后2组Scr、BUN及研究组PTH、β2-MG含量较治疗前明显降低(P<0.01),且研究组PTH、β2-MG含量明显低于对照组,PTH、β2-MG清除率明显高于对照组(P<0.01).治疗后2组血清MDA、hs-CRP、IL-6、TNF-α含量均较治疗前明显降低(P<0.05),且研究组血清hs-CRP、IL-6、TNF-α水平明显低于对照组(P<0.05).治疗后对照组IMT及斑块面积均较治疗前明显增大(P<0.05),研究组IMT及斑块面积无明显变化(P>0.05);治疗后研究组斑块面积明显小于对照组(P<0.01).结论:HD联合HP可明显提高尿毒症患者中大分子毒素清除率,减轻患者机体炎性反应,同时可有效延缓动脉粥样硬化等心血管并发症的发生.%Objective: To investigate the effect of hemodialysis (HD) combined with hemoperfusion (HP) on increasing the clearance rate of uremic toxins and improving the intima of carotid artery. Methods: A total of 40 patients with uremia who were treated in our hospital from May 2015 to Feb 2017 were selected and divided into control group (n=20) and the study group (n=20), and routine HD treatment was performed in the two groups; the study group was treated with HP at the same time, and two groups were treated for 3 months. The levels of toxins and clearance, serum levels of inflammatory factors were measured before and after treatment, and the intima media thickness (IMT) of the two groups was detected by ultrasonic diagnostic apparatus before and after treatment. Results: After treatment, the levels of PTH, BUN in the two groups and PTH, β2-MG in the study group were significantly lower than those before treatment (P<0.01), and the content of PTH and β2-MG in the study group was significantly lower than that in the control group, and the clearance rate of PTH and β2-MG was significantly higher than that of the control group (P<0.01). The serum levels of MDA, hs-CRP, IL-6 and TNF-α in the two groups were significantly lower than those before treatment (P<0.05 or P<0.01), and the serum levels of hs-CRP, IL-6 and TNF-α in the study group were lower than those in the control group (P<0.05 or P<0.01). Compared with before treatment, the IMT and plaque area of the control group significantly increased after treatment (P<0.05 or P<0.01), and there was no significant change in IMT and patch area in the study group (P>0.05); the plaque area of the study group was significantly smaller than that of the control group (P<0.01). Conclusion: HD combined with HP can significantly increase the clearance rate of large molecule toxins in uremic patients, reduce the inflammatory reaction of patients, and effectively delay the occurrence of cardiovascular complications such as atherosclerosis.